Abstrakt
Background: Gallstone ileus is a rare disease. Definite diagnosis is rarely established before surgery.
Optimal treatment strategy, indication to cholecystectomy and management of biliary fistula remains controversial. Methods: A retrospective study and data analysis of patients operated on for gallstone ileus at the Department of Surgery, Motol University Hospital during the past sixteen years (1st January 1989 - 31st December 2004).
Results: The study group consisted of 23 patients - 18 women (78.3%) with a mean age of 76.5 years and 5 men (21.7%), mean age 76.9 years. Enterolithotomy alone was performed in 19 patients (82.7%).
Observed surgical morbidity was high; wound healing problems were the most common, and occurred in 10 patients (43.5%). Mortality rates reached 8.7%.
Further biliary symptoms were noted only in 3 patients (13%). All of them were associated with common bile duct stones.
Conclusions: Early diagnosis and prompt release of the small bowel obstruction is the goal of optimal treatment. Enterolithotomy alone seems to be the method of choice at the time of acute surgery.
Multiple stones can be found in up to 20% patients and should not be missed. Subsequent cholecystectomy should be considered only in patients in good general health with persistent biliary symptoms and cholecystolithiasis.